Form Military Exposures Military Exposures Military Exposures Care Survey 2023_03_06

Military Environmental Exposures Care Survey
V1 DRAFT
01/17/2023
Working Draft, Pre-Decisional, Deliberative document – Internal VA Use Only

EMAIL SUBJECT LINE: Military Environmental Exposures Care Survey (5 minutes)
EMAIL PREHEADER: Tell us about your experience receiving care for military environmental
exposures.

OMB Number: 2900-0876
Expiration: 2/28/2026
Estimated Burden: 5 minutes

Your opinion matters.
Dear ,
We want to hear about your experience with VA healthcare
providers caring for Veterans that have been affected by
military environmental exposures. By responding to this
survey, you will directly help us improve care and better
support Veterans like you. VA wants to provide you with the
best care for health concerns related to military environmental
exposures!
Take Our Survey

Thank you,

Veterans Experience Office
Department of Veterans Affairs

Whether you’re just getting out of the service or you’ve been a civilian for years, the VA Welcome Kit
can help guide you to the benefits and services you’ve earned.
The Veterans Crisis Line provides free, confidential support for Veterans and their families and
friends in crisis. Dial 988 (Press 1) or 1 (800) 273-8255 (Press 1), or text 838255 to receive
confidential support 24/7 (System of Records Notice VA158VA10NC5). Visit https://
www.veteranscrisisline.net for more information.
Additionally, the National Call Center for Homeless Veterans (NCCHV) provides free, confidential
support for Veterans and their family members and friends who are homeless or at risk of
homelessness. Veterans can either call or chat online with the National Call Center for Homeless
Veterans where trained counselors are ready to talk confidentially 24 hours a day, 7 days a week.
Dial 1 (877) 424-3838 or visit https://www.va.gov/HOMELESS/ to receive confidential support.

Please do not reply to this email - it is unmonitored.
If you wish to share your feedback, please do so by .
You received this email because you provided your email address to VA. If you would like to opt out
from receiving future surveys, please click below.
Unsubscribe from this VA Survey | Privacy Policy
By filling out this survey, you are authorizing VA database access to retrieve Veteran contact
information to follow up with you accordingly for purposes of service recovery, potential crisis, or to
learn more about feedback you have shared regarding your experience with VA. VA may utilize
individual Veteran survey data from this survey or other sources to ensure the final scores truly and
accurately represent the experiences of Veterans. This information is collected in accordance with
section 3507 of the Paperwork Reduction Act of 1995. Title 38, United States Code, allows us to ask
for this information. We estimate that you will need an average of 5 minutes to review the
instructions and complete this survey. The results of this survey will be used to inform opportunities
for program improvement in the quality of VA services. Participation in this survey is voluntary, and
your decision not to respond will have no impact on VA benefits or services which you may currently
be receiving. VA cannot conduct or sponsor a collection of information unless a valid OMB control
number is displayed. You are not required to respond to a collection of information if this number is
not displayed. Valid OMB control numbers can be located on the OMB Internet Page at https://
www.reginfo.gov/public/do/PRAMain. Information gathered will be kept private to the extent
provided by law.
Privacy Policy [logic: Hyperlink: https://www.va.gov/privacy-policy/]

Military Environmental Exposures Care Survey
V1 DRAFT
01/17/2023
Working Draft, Pre-Decisional, Deliberative document – Internal VA Use Only

EMAIL SUBJECT LINE: We still want to hear about your experience receiving care for military
environmental exposures (5 minutes)
EMAIL PREHEADER: Tell us about your experience receiving care for military environmental
exposures.

OMB Number: 2900-0876
Expiration: 2/28/2026
Estimated Burden: 5 minutes

Your feedback is important to us.
Dear ,
We care about your experience. Please
take this 5 minute survey to let us know about your
experience receiving care for military environmental
exposures.

Take Our Survey

Thank you,
Veterans Experience Office
Department of Veterans Affairs
Whether you’re just getting out of the service or you’ve been a civilian for years, the VA Welcome Kit
can help guide you to the benefits and services you’ve earned.
The Veterans Crisis Line provides free, confidential support for Veterans and their families and
friends in crisis. Dial 988 (Press 1) or 1 (800) 273-8255 (Press 1), or text 838255 to receive
confidential support 24/7 (System of Records Notice VA158VA10NC5). Visit https://
www.veteranscrisisline.net for more information.
Additionally, the National Call Center for Homeless Veterans (NCCHV) provides free, confidential
support for Veterans and their family members and friends who are homeless or at risk of
homelessness. Veterans can either call or chat online with the National Call Center for Homeless
Veterans where trained counselors are ready to talk confidentially 24 hours a day, 7 days a week.
Dial 1 (877) 424-3838 or visit https://www.va.gov/HOMELESS/ to receive confidential support.

Please do not reply to this email - it is unmonitored.
If you wish to share your feedback, please do so by .
You received this email because you provided your email address to VA. If you would like to opt out
from receiving future surveys, please click below.
Unsubscribe from this VA Survey | Privacy Policy
By filling out this survey, you are authorizing VA database access to retrieve Veteran contact
information to follow up with you accordingly for purposes of service recovery, potential crisis, or to
learn more about feedback you have shared regarding your experience with VA. VA may utilize
individual Veteran survey data from this survey or other sources to ensure the final scores truly and
accurately represent the experiences of Veterans. This information is collected in accordance with
section 3507 of the Paperwork Reduction Act of 1995. Title 38, United States Code, allows us to ask
for this information. We estimate that you will need an average of 5 minutes to review the
instructions and complete this survey. The results of this survey will be used to inform opportunities
for program improvement in the quality of VA services. Participation in this survey is voluntary, and
your decision not to respond will have no impact on VA benefits or services which you may currently
be receiving. VA cannot conduct or sponsor a collection of information unless a valid OMB control
number is displayed. You are not required to respond to a collection of information if this number is
not displayed. Valid OMB control numbers can be located on the OMB Internet Page at https://
www.reginfo.gov/public/do/PRAMain. Information gathered will be kept private to the extent
provided by law.
Privacy Policy [logic: Hyperlink: https://www.va.gov/privacy-policy/]

Military Environmental Exposures Care Survey
V1 DRAFT
01/17/2023
Working Draft, Pre-Decisional, Deliberative document – Internal VA Use Only

The VA provides free, confidential support 24/7 for Veterans and their family and friends. If you
are in crisis, contact the Veterans Crisis Line: Dial 988 (Press 1) or 1 (800) 273-8255 (Press
1), text 838255, or visit https://www.veteranscrisisline.net. If you are homeless or at risk of
homelessness, contact the National Call Center for Homeless Veterans (NCCHV) by dialing
1 (877) 424-3838 or visiting https://www.va.gov/HOMELESS/.

OMB Number: 2900-0876
Expiration: 2/28/2026
Estimated Burden:5 minutes

Help us serve you better.
We want to hear about your experience with VA healthcare providers
caring for Veterans that have been affected by military environmental
exposures. By responding to this survey, you will directly help us improve
care and better support Veterans like you. VA wants to provide you with
the best care for health concerns related to military environmental
exposures!
The following questions ask about your most recent experience with VA
health care for health concerns related to military environmental exposure.
Military environmental exposure(s) include being exposed to airborne
hazards, burn pits, Agent Orange, contaminated water and other things in the
environment during your military service that may impact your health.
This survey should take you approximately 5 minutes to complete.
Please think of your most recent experience with your VA healthcare provider when
answering these questions.
My healthcare provider made me feel respected and valued when talking about my
health concerns with military environmental exposure(s).
Strongly
Disagree

Disagree

Neither

Agree

Strongly
Agree

2

3

4

5

1

Not Applicable
(N/A)

My healthcare provider talked in a way I could easily understand about health concerns
with military environmental exposure(s).
Strongly
Disagree

Disagree

Neither

Agree

Strongly
Agree

2

3

4

5

1

Not Applicable
(N/A)

My healthcare provider seemed well informed about the potential health effects of
military environmental exposure(s).
Strongly
Disagree

Disagree

Neither

Agree

Strongly
Agree

2

3

4

5

1

Not Applicable
(N/A)

My healthcare provider took seriously my health concerns with military environmental
exposure(s).
Strongly
Disagree

Disagree

Neither

Agree

Strongly
Agree

2

3

4

5

1

Not Applicable
(N/A)

My healthcare provider gave me helpful recommendations related to health concerns
with military environmental exposure(s).
Strongly
Disagree

Disagree

Neither

Agree

Strongly
Agree

2

3

4

5

1

Not Applicable
(N/A)

My healthcare provider asked specifically about my health concerns with military
environmental exposure(s).
Yes
No
Don’t know/Don’t remember

My healthcare provider gave me information about the potential health effects of military
environmental exposure(s).
Yes
No
Don’t know/Don’t remember

The following questions are about the VA healthcare system as a whole.
I have confidence that VA has the best trained healthcare providers in military
environmental exposure(s).
Strongly
Disagree

Disagree

Neither

Agree

Strongly
Agree

2

3

4

5

1

Not Applicable
(N/A)

I would like to be able to see a VA specialty healthcare provider in military
environmental exposure(s).
Strongly
Disagree

Disagree

Neither

Agree

Strongly
Agree

2

3

4

5

1

Not Applicable
(N/A)

Overall, I am satisfied with the VA healthcare I’ve received for my health concerns with
military environmental exposure(s).
Strongly
Disagree

Disagree

Neither

Agree

Strongly
Agree

2

3

4

5

1

Not Applicable
(N/A)

I trust VA to take care of my current health conditions that are related to military
environmental exposure(s).
Strongly
Disagree

Disagree

Neither

Agree

Strongly
Agree

2

3

4

5

1

Not Applicable
(N/A)

I trust VA to take care of any future health conditions that may be related to military
environmental exposure(s).
Strongly
Disagree

Disagree

Neither

Agree

Strongly
Agree

2

3

4

5

1

Not Applicable
(N/A)

The following questions are about you.
I have received information from VA about how to file a claim for disability
compensation related to health conditions from military environmental exposure(s).
Yes
No
Don’t know/Don’t remember

Do you currently have health conditions you believe are related to military
environmental exposure(s)?
Yes
No
Not sure

How much are you concerned about your health from military environmental exposure(s)?
Not At All
Slightly
Moderately
Very

Was the healthcare provider who most recently addressed your concerns about military
environmental exposure(s):
Your primary care provider/team
A specialist
A military environmental exposure provider at your local facility
VET-HOME Provider
Other [fill-in]

Finish

By filling out this survey, you are authorizing VA database access to retrieve Veteran contact information to follow up with
you accordingly for purposes of service recovery, potential crisis, or to learn more about feedback you have shared
regarding your experience with VA. VA may utilize individual Veteran survey data from this survey or other sources to ensure
the final scores truly and accurately represent the experiences of Veterans. This information is collected in accordance with
section 3507 of the Paperwork Reduction Act of 1995. Title 38, United States Code, allows us to ask for this information. We
estimate that you will need an average of 5 minutes to review the instructions and complete this survey. The results of this
survey will be used to inform opportunities for program improvement in the quality of VA services. Participation in this survey
is voluntary, and your decision not to respond will have no impact on VA benefits or services which you may currently be
receiving. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are
not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be
located on the OMB Internet Page at https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept private
to the extent provided by law.

Privacy Policy

Military Environmental Exposures Care Survey
V1 DRAFT
01/17/2023
Working Draft, Pre-Decisional, Deliberative document – Internal VA Use Only

The VA provides free, confidential support 24/7 for Veterans and their family and friends. If you
are in crisis, contact the Veterans Crisis Line: Dial 988 (Press 1) or 1 (800) 273-8255 (Press
1), text 838255, or visit https://www.veteranscrisisline.net. If you are homeless or at risk of
homelessness, contact the National Call Center for Homeless Veterans (NCCHV) by dialing
1 (877) 424-3838 or visiting https://www.va.gov/HOMELESS/.

OMB Number: 2900-0876
Expiration: 2/28/2026
Estimated Burden:5 minutes

Thank you for choosing VA
The U.S. Department of Veterans Affairs uses these surveys to collect
your feedback in order to continuously improve your experience with VA
services.
Please visit VA.gov to explore benefits, resources, and information
at VA.

By filling out this survey, you are authorizing VA database access to retrieve Veteran contact information to follow up with
you accordingly for purposes of service recovery, potential crisis, or to learn more about feedback you have shared
regarding your experience with VA. VA may utilize individual Veteran survey data from this survey or other sources to ensure
the final scores truly and accurately represent the experiences of Veterans. This information is collected in accordance with
section 3507 of the Paperwork Reduction Act of 1995. Title 38, United States Code, allows us to ask for this information. We
estimate that you will need an average of 5 minutes to review the instructions and complete this survey. The results of this
survey will be used to inform opportunities for program improvement in the quality of VA services. Participation in this survey
is voluntary, and your decision not to respond will have no impact on VA benefits or services which you may currently be
receiving. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are
not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be
located on the OMB Internet Page at https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept private
to the extent provided by law.

Privacy Policy